bien cd bat lai nghiem trong ghi nhan trong cae thur nghiem lam sing duoc tie'n hanh tai Viet Nam giai loan 2011-.2013" vdi ket qua tuOng Ung: tsao cao day ICi thong tin can thiet (83,3%) va bao cao chua day du
hdng tin (16,7%) [6].
Trong nghien cUu nay thdng tin ve san pham ighien _eUu cd xay ra SAE duac phin loai theo nhdm jiai phiu m i san pham nghien eUu tac ddng len theo )han loai ATC. Thdng tin tai Hinh 2_ T h a n loai san j h a m nghien cUu theo nhdm giai phau ma thudc tac Jung ten" nhdm thude khang khuan dung toan than ed fed luang nhieu nhi't vdi ty le 39,68%. DUng thU hai la isac thude lien quan den he tim mach cijng ehiem mot I'J le SAE kha Idn 29,63%
Nghien eUu n i y cua chung tdi cho thay trong tdng d 27 TNLS xay ra SAE. nhdm thudc khang khuan ung t o i n thin cd 12 nghien cUu chiem 75 SAE, ong khi cac thudc he tim mach cd 56 SAE trong )ng sd 3 nghien cUu Mot nghien cUu TNLS nhdm ac che pham hormon diJng toan thin ngoai trU ormon^sinh due ed 18 SAE, Ket qua eho tha'y hinh 2 idi phan anh mot phan mdi lien quan giiJa SAE va an pham nghien cUu,
KET LUAN VA KIEN NGHj
Sd luang bao cao SAE gCrt ve BDGOD trong giai jan tu nam 2006 di'n het nam 2013 la 189 bao cao Dng 185 TNLS dUOc tien h i n h v i eac bao cao nay cd I hudng tang dan theo thai gian.
Trung vj thdi gian gCfi bao cao la 13 ngay (thdi gian 10 cao nhanh nha't la 0 va cham nhal la 671 ngay).
Bao cao co day du cac thong tin can thie't chiem ty le cao 82,01% trong tdng sd 189 bao cao SAE.
TU ket qua nghien eUu tren chung tdi cd mot sd kien nghi:
Tang cudng to chUc cac Idp t i p hua'n ve ve xCr ly, bao cao SAE eho c i c nghien cUu vien. Ddng thdi, eac thdng tin trong bao c i o can duae danh gia bdi lEC/IRB cac cap.
TAI LIEU THAM KHAO
1 Bo Y te (2012). Thong tU 03/2012nT-BYT: Hudng dan ve thU thuoc trin lam sang.
2. international Conference on Harmonisation of Technical Requirements for Registration of Phannaceuticals for Human use (1996). Guideline for Good Clinical Practice E6 (Rl).
3 Internationa! Conference on Harmonisation of Technical Requirements for Registration of Ptiarmaceuticals for Human use (1995), Clinical Safety Data Management. Definitions and Standards for Expedited Reporting (ETA).
4, Bergvall T„ Noren G N , Lindquist M, (2014),
"vigiGrade' a tool to identify well-documented individual case reports and tiiqhiiqht systematic data quality issues", DrugSaA, 37(1), pp. 65-77
5, Bp Y te (2012), Hudng din bao cao, ghi nhan SAE trong thU nghiim lam sang, ban hanh kem theo Cdng van so 6586/ BYT-K2DT ngay 02/10/2012.
6, LUdng Anh Tung, Le Anh Tuan. Nguyin Hoang Anh, V6 Thi Nhi Ha, Le Ttij Luyen, Nguyin Ngo Quang, Phan tich bao cao bien co bat lai nghiem Irong ghi nhan trong cac thCt nghiem lam sang dUpc lien hanh tai Viit Nam giai doan 2011-2013, Tap chi Y hoc thuc hanh. So 12(943), nsm 2014.
NGHIEN CUfU BOdC D A U VE ALEN H U - B M 5 0 2 TREN BENH N H A N DONG KINH VA MOI LIEN QUAN VOTI PHAN ONG PHU TREN DA CUA LAMOTRIGINE TAI VIET NAM
TOM TAT
Md dau: Thud'c chdng ddng kinh la mdt trong cac lyen nhan thudng g$p gay ra phan Ung phu trin da, r phat ban dang dat san, hdi chUng qua min. hdi (ng Stevens-Johnson va hoai ti^ da nhiem doc. Vai bao cao gan diy da cho rang cd moi lien quan giOa 1 Hi-A-B'1502 vi nguy cd lam tBng phan Ung phu 1 da cOa lamotngine.
Muc tieu: Khao sat ty le alen HLA-B*1502 va moi . quan giUa alen HLA-B*1502 vdi phan Cmg phu I da cOa lamotrigine tren binh nhan ddng kinh tat
"' Nam.
Phuang phap: Nghiin cUu cit ngang trin 63 binh n ddng kinh, trong dd cd 38 doi tuang siy dung
^otrigine. Phan tich alen HLA-B'1502 bing ky thuat '^l-time PCR (Polymerase Chain Reaction) hay phan chu5i polymerase. Benh nhan sCrdung lamotngine
•g ('(nhit 3 thang mi khdng cd bat ky phan Ung phu
^•trin da duac xem la dung nap vdi thuoc.
\
TRAN QUANG TUYEN, NGUYEN hOU CONG PHAN HOANG PHUONG KHANH, CU MY HIEU HANH, VO N G U Y E N NGOC TRANG Binh vien Chuyin Khoa Ngoai Thin Kinh Qudc Te
Kit qua: Nghien cUu bao gom 63 doi tuang, trong dd cd 28 nam, 35 nU, tuoi trung binh tai thai diim chan doan la 18.4 ±12.8. T^ le cd alen HLA-B*1502 la 25,4% (16 benh nhan). Alen HLA-B'1502 gap trong 80% benh nhan cd phan Ung phu tren da do lamotrigine, nhung chi gap trong 9,1% benh nhan dung nap vdi lamotrigine Cd moi lien quan co y nghTa thong ke giOa alen HLA-B*1502 va nguy ca phan Ung phu trin da cua lamotrigine (t^ so chenh OR = 40; khoang tin cay 95%> = 3,3- 463,4, p = 0,004).
Ket luan Ket qua nghien cUu cho thay t^ le cao cHa alen HLA'B'1502 tren benh nhan dong kinh tai Viet Nam Co moi lien quan giiya alen HLA-B'1502 vdi phan Ung phu tren da cQa lamotrigine. Tnjng tuang lai can cd cac nghien cUu vdi cd miu Idn han di lam ro ket qua
Tirkhoi: Benh nhan ddng kinh, phan Ung phu tren
,OC THUC HANH (953) - S6 3/2015
S U M M A R Y
HLA-B'1502 ALLEl£ IN EPILEPTIC PATIENTS AND ASSOCIATED LAMOTRIGINE-RELATED CUTANEOUS ADVERSE REACTIONS - A PILOT STUDY IN VIETNAM
Background: An^epileptie dnigs are among the most common causes of cutaneous adverse reasons, such as mild maeulopapular eruption, hypersensitivity syndrome, Stevens-Johnson syndrome (SJS) and toxic epidermal necrc^ysis (TEN). Some recent studies have reported that the human leukocyte antigen (HLA)- ff1502 allele is associated with an increased risk of lamobigine (LTG)-reiated cutaneous rea(^ons.
Objective: We investigated the frequency of HLA- B'1502 allele and the relation between HLA-B'1502 allele and LTG-related cutaneous reactions in Vietnamese epileptic patients.
Methods: This was a cross-sectional study, including 63 epileptic patients. Thirty-eight subjects were treated with lamotrigine. The presence of HLA- B'1502 was confirmed by real-time polymerase chain reacMon. Patients who had taken LTG for at least 3 months without developing cutaneous adverse reactions were considered to be LTG-tolerant.
Results: Among 63 sulyects (28 men, 35 women, mean age at diagnosis 18.4 ±12.8 years), the frequency of HLA-ff-1502 allele was 25.4% (16 patients). The HLA-^1^2 allele was present in 80%
(4 of 5) of LTG-related cutaneous reac^ons cases but in only 9.1% (3 of 33) of LTG-tolerant groups. The occurrence of LTG-related cutaneous reactions associated with the presence of the HLA-ff'1502 allele (odds ratio (OR) = 40; 95% confidence interval (Cl) = 3.3-483.4; p = 0.004).
Conclusions: This study showed a high rate of HLA-B'1502 allele in epileptic patients in Vietnam.
TTiere was statistical relation between HLA-B'1502 and lamotrigine-related cutaneous adverse reactions.
Future studies with larger sample sizes are suggested to verify the results.
Keywords: Epileptic patients, cutaneous adverse
DATVA'ND^
D o n g k i n h la m o t t r o n g n h u n g b i n h l y t h a n k i n h c d lich siJr t u l i u d d i v a p h o b i e n t r e n k h a p t h d g i d i . T h e o l i d c t i n h dia T o ehUc Y t e T h e g i d i ( W H O ) , h i e n c d k h o a n g 5 0 t r i e u n g u d i m a c t i e n h d p n g k i n h , t r o n g d d 8 0 % b i n h n h i n d c a c n u d c d a n g p h a t t r i e n . T h u d c c h d n g d d n g k i n h d u o c x e m la d i e u t n n e n t a n g c h o b e n h d p n g k i n h , n h d c a c t h u d c n a y m a n h i e u b e n h n h i n d a k h o i b e n h v a c d d U d c c u o c s d n g b i n h t h u d n g . T u y n h i e n , d i c i i n g v d i h i e u q u a k i e m s o i t c d n d d n g k i n h la t a c d u n g p h u c u a ^ u d c , t r o n g d o p h a n Ung d a la m o t t r o n g nhiJTig p h a n U n g b a t Ipi t h u d n g dUdc d e c i p . C i c b i e u h i e n n a y k h a d a d a n g , t U p h a t b a n d a n g d a t s a n , h p i c h U n g q u a m i n c h o d e n h p i chCitig S t e v e n s - J o h n s o n ( S J S ) v i h o a i tCrda n h i i m d o e ( T E N ) [1] [ 6 ] . C a c b i i b a o c a o g a n d i y d a c h o r a n g c d m d i lien q u a n g i i j ^ a l e n H L A - B ' 1 5 0 2 v a n g u y e d l a m t a n g p h a n Ung p h u t r e n d a c u a l a m o t r i g i n e [ 7 ] . T u y n h i e n , c u n g c d m o t v a i n g h i e n cCfu c h o t h a y t r o n g c a c t h u d c c h d n g d d n g k i n h , e h i c d m d i lien q u a n c d y n g h l a t h d n g k e g i i j ^ a l e n H L A - B " 1 5 0 2 v d i p h a n Ung d a d o c a r t i a m a z e p i n e v a p h e n y t o i n [1].
C h o t d i n a y t a i \ ^ e t N a m , v i n chUa c o c d n g b d v g t j le a l e n H L A - B * 1 5 0 2 t r e n b e n h n h a n d d n g kinh, vS c h u a c d c o n g t r i n h n g h i e n ciiu n a o k h a o s a t mdi lien q u a n giOa a l e n H L A - B ' 1 5 0 2 v d i p h a n U n g p h u trfin da d o l a m o t r i g i n e n d i rieng, c u n g n h U t r e n t a t c a c a c thuoc c h d n g d d n g k i n h n d i c h u n g . D o v i y , c h d n g tdi ten h a n h n g h i e n c U u b u d c d a u v d i c a c m u c t i e u s a u :
Khio sat t^ le alen HLA-S-1^2 trin binh nti^n ddng kinh tai Viet Nam.
Quan sat mdi lien quan giOa alen HLA-B'1502 vdi phan Ung phu trin da cOa lamotrigine tin binh nhin ddng kinh.
D O I T U O N G V A P H J O N G P H A P N G H I E N CCfU T h i e t k e ^ n g h i e n cuiu: N g h i e n cCfU c a t n g a n g mo ta.
O o i t U d n g v a p h u o n g p h a p n g h i e n c U u : B e n h n h a n d d n g k i n h , d i e u tri n o i t r t i v i n g o a i tni tai B e n h v i e n C h u y e n k h o a N g o a i t h a n k i n h Q u d c t e t t 1 / 2 0 1 4 d e n 1 0 / 2 0 1 4 .
B i n h n h a n d d n g y t h a m g i a n g h i e n cUu dutfc Urn t h a p c a c t h d n g t i n n h u t u d i , g i d i , c h a n d o a n l i m sang, t h u d c d a n g sCr d u n g , p h a n O h g d i Ung, s a u d d b f r A n h i n d u p e l a y m i u x e t n g h i e m a l e n HLA-BM502.
P h a n U n g di U n g d a d u a c t h u t h a p q u a c a c lan tai k h a m v a q u a d i e n t h o a i .
P h a n t i c h a l e n H L A - B ' 1 5 0 2 b a n g k y thuit^ R e * t i m e P C R ( P o l y m e r a s e C h a i n R e a c t i o n ) h a y p h a n Otig e h u d i p o l y m e r a s e , t h u t i h i e n t a i t m n g t a m y sinh hpc p h i n tO. D a i h p c Y D u p e t h a n h p h d H d C h i M i n h .
B e n h n h i n s^ d i j n g l a m o t r i g i n e t r o n g it nh^t 3 t h i n g m a k h o n g c d b a t k y p h a n U h g p h u n a o tren da d U d c x e m l i d u n g n a p v d i t h u d c .
P h U d n g p h a p x u l y s o l i e u : XCr ly s d l i i u bang p h a n m e m S P S S 2 0 . 0 .
K ^ T Q U A N G H I E N CCOJ
T r o n g t h d i g i a n t U 1 / 2 0 1 4 d e n 1 0 / 2 0 1 4 , chiing tfli k h a o s a t d u p e 6 3 t r u d n g h p p d p n g k i n h c d ket qua x ^ n g h i e m a l e n H L A - B ' 1 5 0 2 . t r o n g d o 3 8 d d i tupng siJ d u n g l a m o t r i g i n e .
T r o n g 6 3 t n J d n g h p p . c o 3 5 n U ( d i i e m 55,6%) vS 2 8 n a m ( 4 4 , 4 % ) . T u d i t r u n g b i n h t a i t h d i d i d m chan d o a n la 1 8 , 4 ± 1 2 , 8 .
T y le H L A - B ' 1 5 0 2 : B a n g 1 : T ^ l i H L A - B ' 1 5 0 2
N = 63 Sd luong T J B %
Dironat'nh O i n g h o p t i l
7 11,1
Dlhopti^
9 14,3
Amlfnt) 47 74,6 N h a n x e t : T r o n g 6 3 b e n h n h a n d d n g kinh, 16 t n / d n g h p p c d a l e n H L A - B ' ' l 5 0 2 , c h i e m ' t } l i 25,4%, t r o n g d o c h i e m u u t h e la a l e n H L A - B ' 1 5 0 2 6 dang di h o p tLf (9 t n J d n g h p p ) .
M o i l i e n q u a n g l u ^ H L A - B ' 1 5 0 2 vh p h i n ihig p h u ^ e n d a 6 b e n h n h a n sur d u n g L a m o M g l n e :
B a n g 2 : M d i l i e n q u a n g i t e H ' L A - B ' 1 5 0 v i phSn fllig 3hu t r e n d a d b e n h n h a n s Q d u n g L a m o t r i g i n e
HLA.B-1502 Am tinh
Duong tinh T6nqsfi
OR = 4tl:95%CI =
P)ianOngtr6nda Ktldnq
30 3 33
C6 1 4 5 3,3-483,4;o = 0,(X14
T4igs«
31 7 3S
Y HOC THUC HANH (953) - s 6 M B
Nhin xet: Alen HLA-B'1502 gap trong 80% benh n h i n ed phan Ung phu t e n da do lamotrigine (4 frin 5), nhung ehi g i p trong 9 , 1 % benh nhan dung nap vdi lamotrigine (3 tren 33).
B A N LUAN Ty le HLA-B'1502
Trong thdi gian tU 1/2014 den 10/2014, chung toi khao sat dupe 63 trUdng hpp ddng kinh cd ket qua xet nghiem alen HLA-B'1502, trong dd cd 38 ddi tupng sd dung lamotrigine.
Theo cac nghien cUu trudc d i y , ti le hien hanh ciia alen HLA-B'1502 k h i cao trong nhieu cong ddng d i n cU C h i u A, T I l i nay thay ddi tU 12-15,7% d ngUdi Malay sdng tai Malaysia v i Singapore; 5,7-14,5% 6 ngudi Han sdng tai Dai Loan, Hong Kong, Malaysia, Singapore; cho den tU 8,5-27,5% d ngudi T h i i Lan.
Tuy nhien ti le n i y lai thap d Sri Lanka, Nhit Ban, H i n Qudc cung nhu 6 Chau Au, Nam My v i dan da trang eOng nhu dan ban dia d Bac My [5].
Nghiin cUu cua chung tdi thuc hien tai Benh vien Chuyen khoa Ngoai than kinh Qudc td tren nhdm ddi tudng la benh nhan dong kinh, Trong 63 benh nhin, 16 trudng hpp cd alen tHLA-B'1502, chidm tj- l i 25,4%, trong do cd 7 trudng hpp alen HLA-B'1502 5 dang ddng hpp tLT (11,1%) va 9 trudng hpp d dang d; hpp tijr (14,3%) (bang 1). Ti le dUdng tinh cao tren nhdm binh nhin nay gian tiep the hien ti le hien hanh cCia alen HLA-B'1502 cd kha nang kha cao d dan sd Viet Nam ndi chung. Vdi 25,4% binh nhin cho ket qua duong tinh, chdng tdi nhan thay ti le nay cao hdn so vdi nhieu nghiin cUu dupe thUe hiin tai cac quoc gia khac, va g i n tuwng dUdng nghien cUu tai Thai Lan vdi ket qua l i 27.5% [5]. Tuy tl le mang alen nay rat dao dong d cac nghiin cUu khic nhau, nhung ket qua dUdng tinh cao cOa trong nghien cUu cfia chUng tdi cho thay day that su la mdt van dd can duac quan tam nham nang cao hieu qua quan ly benh nhan ddng kinh 5 Viet Nam.
Md'i lien quan giu^ HLA-B'1502 va phan Ung phu tren da c> benh nhan sur dung Lamotrigine
SU hien diin ciia alen HLA-B'1502 dupe xem nhu lam tSng nguy cd dj Ung da d benh nhin sit dung thudc chdng ddng kinh [1] [6]. N i m 2004, tac gia Chung v i cdng su lan dau n h i n thdy tren 44 benh n h i n bi hpi chUng Stevens-Johnson do su" dung carbamazepine deu cd mang alen HLA-B'1502 (ti le 100%) so vdi chi 3% tren 101 benh nhan khdng ghi nhan phan Ung da cd mang alen n i y [2]. Tiep sau dd, nhieu nghien eUu duac tien hanh nham khao s i t mdi lien he giiia tinh trang dj Ung da ciia benh n h i n cd sir dung cae thudc chdng ddng kinh vdi alen HLA-B*1502. Tai An Dp, carbamazepine dupc xem l i mdt trong nhCftig nguyen n h i n chi'nh gay nen hdi chUng SJS/TEN, tai Singapore va Malaysia cung cho rang 27,7 den 35,7% trudng hpp SJS/TEN cd lien quan den Carbamazepine [3]. Chinh tU nhuTig ki't qua nay ma n i m 2007, FDA d i dua ra khuyen cao nen tam soat alen HLA-B'1502 tnidc khi bat dau s& dung carbamazepine d nhdm benh nhan Chau A.
Lamotrigine la thudc dieu tri ddng kinh dupe sCf dung phd bien; ciJng vdi carbamazepine, day cung dupc xem la mot trong nhOng thudc chdng ddng kinh cd lien quan d i n phan Ung dj uTig da cl benh nhan.
Nghien cUu phan tich tong hpp thuc hien nam 2014 cho kdt qua tren 12 benh nhan bj hoi ehUng SJS/TEN gay ra bdi lamotrigine cd den 33,3% mang alen HLA- B'1502 so vdi ehi 9,4% trong sd 128 benh nhin d nhdm dung nap thude cd alen nay [7]. Mot nghien cUu khac cung cho thay d nhdm ed mang alen HLA- B'1502, ti l i benh n h i n bi hpi c^Ung SJS/TEN do sit dung lamotrigine cao 4,51 lan so vdi binh nhan khdng phit hien HLA-B1502 [4]. Nghien cUu cOa chdng toi cd 38 benh nhin dpng kinh si> dung lamotrigine, trong dd ghi nhin 5 benh n h i n cd phan Ung phu tren da v i da dupc t u van ngUng thudc. Trong nhdm benh nhin di Cmg da cd den 80% (4/5 benh nhan) mang alen HLA- B'1502 trong khi nhdm dung nap vdi lamotngine chi ed 9,1% (3/33 benh nhin) mang alen nay, SU khac biet giiJa 2 nhdm cd y nghTa thdng ke (OR = 40; 95% Cl = 3,3 - 483,4; p = 0,004) (bang 2).
M i c dij han che ve sd lUpng binh nhan, nghien cUu cOa chung tdi cho thay ti l i alen HLA-B'1502 cao trong cdng ddng ngudi Viet Nam cung vdi nguy ed di Ung da t i n g len dang ke ddi vdi ngUdi SIJT dung lamotngine cd mang alen nay, tUdd chung tdi cho rang khdng nhOng ddi vdi carbamazepine ma cdn vdi ca lamotrigine, chung ta can xet nghiim alen HLA-B'1502 tardc khi khdi dau sO dung thude nham lam giam nguy cd dl Ung da cd kha nang g i y nguy hiem cho benh nhan. Cae nghien cUu Idn hdn cung can thuc hien vdi lamotrigine cung nhu c i c thude ehdng dong kinh khac nham n i n g cao hieu qua dieu tri dong kinh d Viet Nam.
KET LUAN
TJ l i cd alen HLA-B'1502 tren benh nhin dong kinh tai Viet Nam l i 25,4%.
Cd mdi lien quan cd y nghTa thdng ke giija alen HLA-B'1502 va nguy cd phan Ung phu tren da cOa lamotrigine.
Trong tuong lai can cd cac nghien eUu vdi ed m i u Idn hdn de lam rd ket qua.
TAI LI^U THAM KHAO
1. Cheung Y. K., Cheng S. H., Chan E. J., Lo S. V., Ng M. H,, et al (2013), "HLA-B alleles associated with severe cutaneous reactions to antiepileptic drugs in Han Chinese".
Epilepsia, 54 (7), pp. 1307-14.
2 Chung W. H., Hung S. I., Hong H. S., Hsih M. S., Yang L. C , et al. (2004), "Medical genetics: a marker for Stevens-Johnson syndrome". Nature, 428 (6982), pp. 486.
3. Fen-ell P B., McLeod H. L. (2008), "Carbamazepine, HLA-B'1502 and risk of Stevens-Johnson syndrome and toxic epidermal necrolysis' US FDA recommendations'".
Pharmacogenomics, 9 (10), pp. 1543-6.
4. Ll X., Yu K., Mei S , Huo J., Wang J., et al. (2014).
"HLA-B*1502 Increases the Risk of Phenytoin or Lamotrigine Induced Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis: Evidence from a Meta-analysis of Nine Case-control Studies". Drug Res (Stuttg).
5. Lim K.S, Kwan P., Tan C.T (2008), "Assodation of HLA-B'1502 allele and carbamazepine-induced severe
Y HOC THl/C H A N H (953) - S 6 3/2015
adverse cutaneous drug reaction among Asians, a review
". Neurotogy Asia, 13, pp. 15-21.
6. Lv Y. D., Min F. L., Liao W. P.. He N., Zeng T., et al.
(2013), "The association between oxcartoazepine-induced maeulopapular eaiption and HLA-B alleles in a northem Han Chinese population". SMC Neurol, 13, pp. 75.
7. Zeng T.. Long Y. S., Min F. L . Liao W. P., ShiY.%
(2014), "Association of HLA-B'1502 allele w^
lamotrigine-induced Stevens-Johnson syndrome and t ^ epidermal necrolysis in Han Chinese subjects: a mab' analysis". Int J Dermatol.
DIEU TRj CONG DimNG VAT NANG TRONG MIENG NIEU DAO DONG THAP VflTl MANH GHEP BJ
TOM TAT
Muc dich: Chung tdi gidi thieu ky thuat dieu trj di tit cong duang vat nBng trong mieng nieu dao ddng thap bing manh ghip bi di md ring can tring vung bung duang vat.
Sd lieu & phuang phap: 44 trudng hpp cong duang v$t nBng kem mieng nieu dao ddng tha'p dupe dieu tri tUthing 3 - 201 idin thing 9 - 2013, tuii tU 1 din 14 Phin loai dua vio thuang tin giai phiu hpc cOa cong duang vat, diiu tri theo tiiu chuan phan loai va xac nhan dUdng vat th^ng sau mi.
Kit qua: Bin muo/ ddn trudng hap cong duang vat nBng dupc dung ky thuat md ring can tring vdi manh ghip bi, sau dd tao hinh nieu dao thi 2 vdi ky thuat cudn dng tai chd. Vidi gian theo ddi tU 6 thang din 2 nBm.
Kdt luin: Chung tdi tin ring viec diiu tri_ cong duang vat nBng vdi ky thuat md ring can tring vdi minh ghip bi la ky thuat chon lua nhim dem lai hinh ding dUdng vat thing han so vdi phuang phap khac.
Tifkhda: Manh ghep bi, duang vit.
SUMMARY
DERMAL GRAFT FOR SEVERE CHORDEE WITH HYPOSPADIAS
Purpose: We present the technique of using a small dermal graft to augment the ventral tunica albuginea in the patient with severe chordee.
Materials & methods: We reviewed the records of 44 patients who underwent severe chordee correction between March 2011 and September 2013. The age ranged from 1 to 14. Dermis was used in 44 patients We grouped cases according to the etiology of chordee and we treated in the standard and a straight phallus was confirmed in all postoperatively.
Results: One dermal graff was placed in 44 patients. Second stage urethral.
reconstruction was done 6 months later with a Thiersch Duplay tube. Patient age ranged from 1 to 14 years. All patients have been followed for a minimum of 6 months and a maximum of 2 years.
Conclusions: We bilieve that the additional penile length achieved with dermal graft results In a depent phallus and cosmetic preferable to that of plication only.
Keywords: H^xispadias, chordee.
DATVANB^
Cong duang vat l i bien dang b i m sinh cd hay khdng di kem vdi mieng nieu dao ddng thap, 16 tieu cao [4][6][9]. Cd nhieu ky thuat trong viic dieu tn eong
LE THANH HUNG, LE CONG T H A N G LE TAN SON, VU Lg CHUYEN
dUdng v i t tuy thuoc vao tUng loai thuang tdn giai phlu [11,[8]. Trong cong duang vat nhe v i tnjng binh viec cat bd md xd vCing bung duang v i t hay khiu gap the hang (Nesbit plication) thudng cho ket qua tuyet v^
[1],[4],[8]. Tuy nhien vdi cong duang v i t nang (hon 30 do) do mi't can ddi cOa bao trang duang vat (tunica albuginea) viee dieu tri bang c i c h khiu gap the hang td ra khdng hiiu qua do lam ngan duang vat. gap cudng mach mau than kinh vung luhg dUdng vat va cong tai phat [1],[2],[3],[7]- Chung tdi gidi thieu kyihuilt md ring c i n trang vung bung duang v i t bang manh ghep bi (dennal graft) lay tU ben trong dieu tq cac trudng hpp cong duang vat nang dua v i o su hllu tHet ve mo hpc cQa manh ghep bi.
SO LIEU & PHL/ONG PHAP
TUthing 3 - 2 0 1 1 den thing 9-2013cd44tm6n9 hpp eong duang vat n i n g kem mieng nieu dao ding thap dupc dieu tri tai khoa Ngoai Benh vien Nhi Ddng I, Phuang phap nghiin cUu: Tien cUu md ta co can thiep l i m sang.
Tat ca benh nhi mieng nieu dao ddng thap cd cong duang v i t hdn 30 dp khi l i m test cuang duang vat (sau khi d i cat san nieu dao).
Tudi benh nhan tU2 den 14.
Trong sd 44 trudng hpp eong dUdng vat ning nft/
Chung tdi phai ap dung ky thuat md ring can trang vi ghep manh bi. Tao hinh n i i u dao dupe tien hanh thi 2 sau 6 thing.
Ky thuat: Sau khi sat trung da duang vat ha vj vi vung ben ndi dU djnh lay da ghep tien hanh dat tti6nfl nuoi an (feeding tube) thfch hdp v i o niiu dao. Dung Viet vd trung ve vong trdn quanh da quy dau each Vnk quy dau cd 0,5cm. chich thudc te Lidocaine (0,1?i adrenaline) vdng theo dudng ve vong trdn. Phliu tidi tach da dUdng vat ra khoi t h i n duang v i t (deglove) eho tdi t i n bd xuang mu. Sau do chUng tdi lam ted cUdng duang v i t (artificial erection) bang each buoc gan-ot gdc duBng v i t v i bam nudc mudi sinh ly vao 0 hang qua kim budm de danh gia mUc dp cong ciliB dUdng vat va tuy theo mUc dp cong ma dUa ra cac each sCr tri khac nhau de lam thang duang v i t nhSm dua dUdng vat trd ve hinh dang binh thudng. Vdi cong dUdng v i t ning dp eong hdn 30 dd chiing tdi cat tuf) trang (tunica albuginea) chd cong vung bung duanfl vat tu VI tri 3 gid den 9 gid trinh l i m tdn thuang W hang ndi cd dpng mach s i u dUdng vit, luc nay dUtJnB
Y HOC THUC HANH (953) - SO 3/2*
